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March 2014 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for March 2014. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

One in 12,000 Hospital Deliveries Result in Cardiac Arrest

FRIDAY, March 28, 2014 (HealthDay News) -- Cardiac arrest occurs in approximately one of every 12,000 hospitalizations for delivery, according to a study published in the April issue of Anesthesiology.

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NCHS Estimates Health Insurance Coverage for 2013

THURSDAY, March 27, 2014 (HealthDay News) -- In the first nine months of 2013, 6.7 percent of children and 20.5 percent of adults were uninsured, according to a study published online March 27 by the National Center for Health Statistics (NCHS).

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Incidence of Hospital-Acquired Anemia During MI Varies

THURSDAY, March 27, 2014 (HealthDay News) -- For patients hospitalized with myocardial infarction, the incidence of hospital-acquired anemia (HAA) varies considerably across hospitals, according to a study published in the April 1 issue of The American Journal of Cardiology.

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1 in 25 Inpatients Has Health Care-Associated Infection Daily

WEDNESDAY, March 26, 2014 (HealthDay News) -- There were an estimated 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011, according to research published in the March 27 issue of the New England Journal of Medicine.

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White House Extends Affordable Care Act Enrollment Deadline

WEDNESDAY, March 26, 2014 (HealthDay News) -- Americans who've started applying for health insurance under the Affordable Care Act but can't complete the process by the March 31 enrollment deadline will be given an extension.

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AMA Introduces Medical Education Initiative

WEDNESDAY, March 26, 2014 (HealthDay News) -- The American Medical Association's (AMA) Accelerating Change in Education initiative is being introduced in 11 medical schools in an effort to shift the focus of education toward real-world practice and competency assessment, according to an AMA report.

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Americans Seem Unprepared for Health Insurance Exchanges

WEDNESDAY, March 26, 2014 (HealthDay News) -- Individuals in the United States seem not to be sufficiently informed about the health insurance exchanges established by the Affordable Care Act (ACA), according to a study published online March 24 in the Proceedings of the National Academy of Sciences.

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Surgical Site Infection Rate Down With Lower Target Glucose

TUESDAY, March 25, 2014 (HealthDay News) -- For patients undergoing hepato-biliary-pancreatic surgery, having a lower blood glucose target (4.4 to 6.1 mmol/L) is associated with reduced incidence of surgical site infection (SSI), according to a study published online March 12 in Diabetes Care.

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Most Bloodstream Infections Are Community-Onset

TUESDAY, March 25, 2014 (HealthDay News) -- Most bloodstream infections (BSIs) are community-onset and health care-associated, and Staphylococcus aureus is the most common pathogen, according to a study published online March 18 in PLOS ONE.

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Mortality Up for PCI After Cardiac Arrest

MONDAY, March 24, 2014 (HealthDay News) -- Patients who undergo percutaneous coronary intervention (PCI) after cardiac arrest are more likely to have more complex lesions, cardiogenic shock, and higher mortality, according to research published in the April 1 issue of The American Journal of Cardiology.

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Patient Request Impacts Doc Prescribing Behavior

MONDAY, March 24, 2014 (HealthDay News) -- Patients requesting specific medications are more likely to be prescribed those medications, according to research published in the April issue of Medical Care.

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Hemicraniectomy Also Beneficial for Older Patients

FRIDAY, March 21, 2014 (HealthDay News) -- For older patients with middle-cerebral-artery infarction, early decompressive hemicraniectomy increases survival without severe disability, according to a study published in the March 20 issue of the New England Journal of Medicine.

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Practices Can Take Steps to Improve Care Transitions

FRIDAY, March 21, 2014 (HealthDay News) -- Implementation of a rigorous process can improve transitions of care, according to an article published March 10 in Medical Economics.

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Electrolarynx Allows Speech in Orally Intubated Patients

THURSDAY, March 20, 2014 (HealthDay News) -- An electrolarynx can be used successfully in orally intubated patients receiving mechanical ventilation, according to a letter to the editor published in the March 20 issue of the New England Journal of Medicine.

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Pre-Existing Psych Diagnoses Higher in Critically Ill Patients

WEDNESDAY, March 19, 2014 (HealthDay News) -- Existing psychiatric diagnoses are more common in critically ill patients compared to other hospitalized patients and the general population, according to a study published in the March 19 issue of the Journal of the American Medical Association.

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Definition of Pneumonia Impacts Hospital Mortality Rates

TUESDAY, March 18, 2014 (HealthDay News) -- Risk-standardized hospital mortality rates are higher with a broader versus a narrower definition of pneumonia, according to a study published in the March 18 issue of the Annals of Internal Medicine.

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Insurers Must Offer Same-Sex Couples Spousal Benefits

MONDAY, March 17, 2014 (HealthDay News) -- Health plans that offer benefits for heterosexual couples must do the same for same-sex married couples, the Obama administration says.

Other Health Highlights: March 17, 2014

Rx Expenditures Expected to Rise in 2014

MONDAY, March 17, 2014 (HealthDay News) -- Drug costs are projected to rise 3 to 5 percent across all care settings in 2014, according to a study published in the March 15 issue of the American Journal of Health-System Pharmacy.

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Better Ruptured Abdominal Aortic Aneurysm Outcomes in U.S.

MONDAY, March 17, 2014 (HealthDay News) -- Outcomes for patients with ruptured abdominal aortic aneurysm (rAAA) are better in the United States than in England, with common factors suggesting strategies for outcome improvement, according to a study published in the March 15 issue of The Lancet.

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Chronic Hyperglycemia Tied to Worse Surgical Outcomes

FRIDAY, March 14, 2014 (HealthDay News) -- Chronic hyperglycemia (A1C >8 percent) is associated with poor surgical outcomes, as measured by an increased hospital length of stay (LOS), according to a study published in the March issue of Diabetes Care.

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Improving EHR Interoperability Is a National Priority: HHS

FRIDAY, March 14, 2014 (HealthDay News) -- Interoperability of electronic health record (EHR) systems is a national priority of the Office of the National Coordinator for Health Information Technology, according to an article published March 4 in Medical Economics.

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Benefits of Faster Thrombolysis Time Quantified

FRIDAY, March 14, 2014 (HealthDay News) -- Faster thrombolysis treatment is associated with improved stroke outcome, with each minute of onset-to-treatment time saved correlating with an additional 1.8 days of healthy life, according to a study published online March 13 in Stroke.

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Repeat Spine Imaging Frequent With Injured Patient Transfers

THURSDAY, March 13, 2014 (HealthDay News) -- There is a substantially high rate of repeat spine imaging when patients with known spinal injuries are transferred from an outside hospital (OSH) to a tertiary receiving institution (RI), according to a study published in the Feb. 15 issue of Spine.

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Oldest Old at High Risk for Insulin-Related Hypoglycemia

THURSDAY, March 13, 2014 (HealthDay News) -- Among insulin-treated patients, those 80 years of age and older have the highest rate of emergency department visits and subsequent hospitalizations for insulin-related hypoglycemia and errors (IHEs), according to research published online March 10 in JAMA Internal Medicine.

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Adoption of Surgical Safety Checklists Doesn't Cut Mortality

WEDNESDAY, March 12, 2014 (HealthDay News) -- Adoption of surgical safety checklists is not associated with significant reductions in mortality or surgical complications, according to a study published in the March 13 issue of the New England Journal of Medicine.

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Prehospital Stroke Alerts Speed Door-to-CT Times

WEDNESDAY, March 12, 2014 (HealthDay News) -- Emergency medical services (EMS) prenotification regarding the arrival of patients who have had a stroke allows patients to bypass the emergency department and undergo computed tomography (CT) in a timely manner, according to a study published in the March issue of Neurosurgery.

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White House: More Than Four Million Have Signed Up for ACA

TUESDAY, March 11, 2014 (HealthDay News) -- More than four million Americans have signed up for health coverage through state and federal insurance marketplaces established by the Affordable Care Act, the Obama administration announced Tuesday.

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Medicare Drug Plan Changes Withdrawn by White House

TUESDAY, March 11, 2014 (HealthDay News) -- Proposed changes to the Medicare prescription drug program have been withdrawn by the Obama administration after strong opposition from patient groups.

Other Health Highlights: March 11, 2014

Discrepancies ID'd in Studies on ClinicalTrials.gov, Journals

TUESDAY, March 11, 2014 (HealthDay News) -- Nearly all clinical trials reported on ClinicalTrials.gov and published in high-impact journals report at least one discrepancy in cohort, intervention, or results, according to a research letter published in the March 12 issue of the Journal of the American Medical Association.

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Nocturnal Respiratory Rate Predicts Cardiac Risk After MI

MONDAY, March 10, 2014 (HealthDay News) -- Among survivors of acute myocardial infarction (MI), nocturnal respiratory rate (NRR) is significantly associated with cardiac mortality, particularly non-sudden cardiac death, according to research published online March 5 in the Journal of the American College of Cardiology.

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Keeping Salaries Secret Harms Worker Performance

MONDAY, March 10, 2014 (HealthDay News) -- Keeping salaries secret hurts worker performance and increases turnover of top talent, according to a study published online Jan. 13 in the Academy of Management Journal.

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Higher Cardiovascular Events Risk After Outbursts of Anger

FRIDAY, March 7, 2014 (HealthDay News) -- There is a heightened risk of cardiovascular events in the hours following an angry outburst, according to research published online March 3 in the European Heart Journal.

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Gender Gap Exists in Domestic Duties of Working Physicians

FRIDAY, March 7, 2014 (HealthDay News) -- Gender differences exist in domestic activities among career-oriented academic physicians with children, according to a study published online March 3 in the Annals of Internal Medicine.

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Chest Complaints More Costly in Obese Patients

FRIDAY, March 7, 2014 (HealthDay News) -- Higher body mass index (BMI) is associated with increased cost of care and longer hospital stays for patients who present to the emergency department with chest pain and dyspnea, according to research published online March 4 in Circulation: Cardiovascular Quality and Outcomes.

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In STEMI, Hyperglycemia Tied to Larger Myocardial Area-at-Risk

FRIDAY, March 7, 2014 (HealthDay News) -- For patients with ST-segment elevation myocardial infarction (STEMI), hyperglycemia is associated with larger area-at-risk and infarct size, and the effect of exenatide treatment is independent of glucose levels, according to a study published online Feb. 28 in Diabetes.

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Palliative Chemo for Terminal Cancer Linked to Death in ICU

FRIDAY, March 7, 2014 (HealthDay News) -- Terminally ill patients with cancer who receive chemotherapy at the end of life are at increased risk of dying in an intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) and/or mechanical ventilation, according to research published March 4 in BMJ.

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Relative Value Units Useful In Evaluating Practice Finances

THURSDAY, March 6, 2014 (HealthDay News) -- The Relative Value Unit (RVU) is a useful tool for managing practice finances, according to an article published Feb. 25 in Medical Economics.

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Drop in Compensation Gap for Primary Care Docs, Specialists

THURSDAY, March 6, 2014 (HealthDay News) -- From 2012 to 2013, there was a 5.7 percent increase in the median total cash compensation for primary care physicians, with a smaller gap seen for medical and surgical specialists, according to the results of a recent survey from SullivanCotter.

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Value-Based Insurance Plans Can Up Rx Adherence

WEDNESDAY, March 5, 2014 (HealthDay News) -- Value-based insurance design (VBID) plans with certain features aside from solely lowering cost sharing can increase medication adherence, according to a study published in the March issue of Health Affairs.

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CDC: Antibiotics Often Prescribed During Hospitalization

WEDNESDAY, March 5, 2014 (HealthDay News) -- Inpatients frequently receive antibiotics, and in many cases antibiotic prescribing could be improved, according to a report published in the March 4 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly.

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WHO Program Improves U.S. Medical Facility Hand Hygiene

WEDNESDAY, March 5, 2014 (HealthDay News) -- For U.S. health care facilities, participation in the World Health Organization (WHO) global campaign to improve hand hygiene practices is associated with improved hand hygiene, according to a study published in the March issue of the American Journal of Infection Control.

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Gap in Regulatory Coverage Affects 5 to 16 Percent of Trials

WEDNESDAY, March 5, 2014 (HealthDay News) -- Human subjects protections (HSP) policies do not provide regulatory coverage for all clinical trials, while up to about a quarter of trials are considered overlap trials, according to a research letter published in the March 5 issue of the Journal of the American Medical Association.

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Docs Nominate Top U.S. Internal Medicine Residency Programs

TUESDAY, March 4, 2014 (HealthDay News) -- The top U.S. internal medicine residency programs have been ranked by physicians and include Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Brigham and Women's Hospital in Boston, and the University of California in San Francisco, according to an article published by U.S. News & World Report.

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Longer LOS for New Heart Failure in Medicaid Patients

MONDAY, March 3, 2014 (HealthDay News) -- Medicaid patients and patients with more comorbidities have a longer length of stay (LOS) for incident heart failure, compared to other hospitalized cases, according to a study published in the January/February issue of the Journal for Healthcare Quality.

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Women-Specific Research Is Still Inadequate

MONDAY, March 3, 2014 (HealthDay News) -- Women are still underrepresented in medical science and research, and sex differences are often ignored, according to a report published March 3 by the Brigham and Women's Hospital.

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Persistent Post-Cardiac Surgery Pain Seen at 24 Months

MONDAY, March 3, 2014 (HealthDay News) -- For patients undergoing cardiac surgery, persistent postoperative pain decreases over time and is 9.5 percent at 24 months after surgery, according to a study published online Feb. 24 in CMAJ, the journal of the Canadian Medical Association.

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CMS: No More Delays to ICD-10 Implementation Deadline

MONDAY, March 3, 2014 (HealthDay News) -- There will be no more delays to the Oct. 1, 2014, deadline for implementation of the International Classification of Diseases, 10th Revision (ICD-10), according to an article published Feb. 27 in Medical Economics.

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